Rebecca T. Brown, MD, MPH; L. Grisell Diaz-Ramirez, MS; W. John Boscardin, PhD; Sei J. Lee, MD; Michael A. Steinman, MD
Note: Drs. Brown and Steinman are employees of the San Francisco Veterans Affairs Medical Center.
Disclaimer: The opinions expressed in this manuscript may not represent those of the U.S. Department of Veterans Affairs.
Grant Support: By grant KL2TR000143 from the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), through University of California, San Francisco, Clinical and Translational Sciences Institute (Dr. Brown) and grants K23AG045290 (Dr. Brown), P30AG044281 (Drs. Brown and Steinman), and K24AG049057 (Dr. Steinman) from the National Institute on Aging (NIA) at the NIH.
Disclosures: Dr. Lee reports grants from NIA during the study and grants from Veterans Affairs Health Services Research and Development Service outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0496.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: See Supplement 1. Statistical code: See Supplement 2. Data set: Publicly available from the HRS Web site at http://hrsonline.isr.umich.edu/.
Requests for Single Reprints: Rebecca T. Brown, MD, MPH, San Francisco Veterans Affairs Medical Center, 181G, 4150 Clement Street, San Francisco, CA 94121; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Brown, Boscardin, Lee, and Steinman and Ms. Diaz-Ramirez: San Francisco Veterans Affairs Medical Center, 181G, 4150 Clement Street, San Francisco, CA 94121.
Author Contributions: Conception and design: R.T. Brown, M.A. Steinman.
Analysis and interpretation of the data: R.T. Brown, L.G. Diaz-Ramirez, W.J. Boscardin, M.A. Steinman.
Drafting of the article: R.T. Brown.
Critical revision for important intellectual content: R.T. Brown, L.G. Diaz-Ramirez, W.J. Boscardin, S.J. Lee, M.A. Steinman.
Final approval of the article: R.T. Brown, L.G. Diaz-Ramirez, W.J. Boscardin, S.J. Lee, M.A. Steinman.
Provision of study materials or patients: R.T. Brown.
Statistical expertise: L.G. Diaz-Ramirez, W.J. Boscardin.
Obtaining of funding: R.T. Brown, M.A. Steinman.
Administrative, technical, or logistic support: R.T. Brown.
Collection and assembly of data: L.G. Diaz-Ramirez.
Difficulties with daily functioning are common in middle-aged adults. However, little is known about the epidemiology or clinical course of these problems, including the extent to which they share common features with functional impairment in older adults.
To determine the epidemiology and clinical course of functional impairment and decline in middle age.
The Health and Retirement Study.
6874 community-dwelling adults aged 50 to 56 years who did not have functional impairment at enrollment.
Impairment in activities of daily living (ADLs), defined as self-reported difficulty performing 1 or more ADLs, assessed every 2 years for a maximum follow-up of 20 years, and impairment in instrumental ADLs (IADLs), defined similarly. Data were analyzed by using multistate models that estimate probabilities of different outcomes.
Impairment in ADLs developed in 22% of participants aged 50 to 64 years, in whom further functional transitions were common. Two years after the initial impairment, 4% (95% CI, 3% to 5%) of participants had died, 9% (CI, 8% to 11%) had further ADL decline, 50% (CI, 48% to 52%) had persistent impairment, and 37% (CI, 35% to 39%) had recovered independence. In the 10 years after the initial impairment, 16% (CI, 14% to 18%) had 1 or more episodes of functional decline and 28% (CI, 26% to 30%) recovered from their initial impairment and remained independent throughout this period. The pattern of findings was similar for IADLs.
Functional status was self-reported.
Functional impairment and decline are common in middle age, as are transitions from impairment to independence and back again. Because functional decline in older adults has similar features, current interventions used for prevention in older adults may hold promise for those in middle age.
National Institute on Aging and National Center for Advancing Translational Sciences through the University of California, San Francisco, Clinical and Translational Sciences Institute.
Brown RT, Diaz-Ramirez LG, Boscardin WJ, Lee SJ, Steinman MA. Functional Impairment and Decline in Middle Age: A Cohort Study. Ann Intern Med. [Epub ahead of print 31 October 2017]167:761–768. doi: 10.7326/M17-0496
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Published: Ann Intern Med. 2017;167(11):761-768.
Published at www.annals.org on 31 October 2017
Geriatric Medicine, Healthcare Delivery and Policy.
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